18 August 2026 : Original article
Immunosuppression Withdrawal in Pediatric Liver Transplant Recipients With Posttransplant Lymphoproliferative Disorder: A Single-Center Retrospective Study
Ying Liu ABCDEFG 1,2,3,4,5, Ru-Zhou Cai
ABCDEF 2,3,4,5,6, Wei Qu ACDE 2,3,4,5,6, Lin Wei ADE 2,3,4,5,6, Zhi-Gui Zeng ADE 2,3,4,5,6, Zhi-Jun Zhu ACDE 2,3,4,5,6, Li-Ying Sun ABCDEFG 2,3,4,5,7*
DOI: 10.12659/AOT.952021
Ann Transplant 2026; 31:e952021
Table 2 Clinical features, immunosuppression management, and graft outcomes of patients with PTLD.
| Case | Clinical features | Histological classification | IS adjustment | Anti-PTLD therapy | PTLD outcome | ||||
|---|---|---|---|---|---|---|---|---|---|
| 1 | Fever, distension, ascites | Burkitt lymphoma | Tacrolimus tapered | R-CHOP, 4 cycles | CR | ||||
| 2 | Fever, lymphadenopathy | Infectious mononucleosis PTLD | Methylprednisolone 8 mg/day, tapered | Rituximab, 2 cycles | CR | ||||
| 3 | Fever, splenomegaly, anemia, liver dysfunction, multiple enlarged mesenteric lymph nodes | Polymorphic PTLD | Methylprednisolone 4 mg/day, tapered | Rituximab, 1 cycle | CR | ||||
| 4 | Progressive enlargement of cervical lymph nodes | Classical Hodgkin lymphoma–like PTLD | Complete ISW | ABVD, 2 cycles; Cycle A: cytosine arabinoside, etoposide; COPP/ABV; Cycle C: cyclophosphamide, doxorubicin, vincristine and prednisone; radiation | CR | ||||
| 5 | Enlarged cervical lymph nodes | Infectious mononucleosis PTLD | Methylprednisolone 6 mg/day, tapered | Rituximab, 1 cycle | CR | ||||
| 6 | Fever, anemia, distention, intestinal perforation | Infectious mononucleosis PTLD | Methylprednisolone 4 mg/day, tapered | Partial small-intestinal resection; rituximab, 4 cycles | CR | ||||
| Case | Time from IS adjustment to complete ISW (months) | Time between LT and complete ISW (months) | Duration of ISW (months) | Graft dysfunction (yes/no) | Liver biopsy | IS restart | Liver function of the last follow-up | ||
| ALT/AST (IU/L) | TB/DB (μmol/L) | ALP/GGT (IU/L) | |||||||
| 1 | 6 | 38 | 39 | No | Borderline rejection | Tacrolimus 0.5 mg/day | 27/38 | 18/7 | 183/37 |
| 2 | 27 | 38 | 48 | No | No ejection | - | 15/25 | 6.1/3.3 | 175/10 |
| 3 | 29 | 38 | 56 | No | No ejection | - | 19/38 | 13.3/3.8 | 267/13 |
| 4 | 0 | 27 | 60 | No | No ejection | - | 28/42 | 11.7/2.6 | 228/13 |
| 5 | 22 | 33 | 36 | No | No ejection | - | 25/31 | 18.8/7.3 | 161/27 |
| 6 | 6 | 19 | 4 | Yes | Mild rejection | Methylprednisolone 4 mg/day | 34/47 | 6.7/2.5 | 176/54 |
| IS – immunosuppression; ISW – immunosuppression withdrawal; ABVD – adriamycin, bleomycin, vinblastine and dacarbazine; COPP/ABV – cyclophosphamide, vincristine, procarbazine, prednisone, adriamycin, bleomycin and vinblastine; CR – complete remission; R-CHOP – rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone; PTLD – post-transplant lymphoproliferative disorder. | |||||||||